Question

Describe three different treatment options for depression.

Name the characteristics of each of the three types of bipolar disorder.

What is a key treatment for bipolar disorder?

Answer 1

1. Treatments for depression:

a. Pharmacotherapy: Four basic types of antidepressant medications are used to treat depressive disorders: selective-serotonin reuptake inhibitors (SSRIs), mixed reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase (MAO) inhibitors. The first category of antidepressant medications was developed in the 1950s; these medications are known as monoamine oxidase inhibitors (MAOIs) because they inhibit the action of monoamine oxidase—the enzyme responsible for the breakdown of norepinephrine and serotonin once released. For most moderately to seriously depressed patients, including those with dysthymia, the drug treatment of choice since the early 1960s until about 1990 was one of the standard antidepressants (called tricyclic antidepressants because of their chemical structure) such as imipramine, which are known to increase neurotransmission of the monoamines (primarily norepinephrine and to a lesser extent serotonin. rimarily because of the side effects and toxicity of tricyclics, physicians have increasingly chosen to prescribe one of the antidepressants from the selective serotonin reuptake inhibitor (SSRI) category. These SSRI medications are generally no more effective than the tricyclics; indeed some findings suggest that the tricyclics are more effective than SSRIs for severe depression.

b. Cognitive Behavioral Therapy: Beck’s cognitive therapy grew directly out of his observations of the role of deep-seated negative thinking in generating depression (Beck, 1967, 1976; Young et al., in press). Clients are taught to examine carefully their thought processes while they are depressed and to recognize “depressive” errors in thinking. This task is not always easy, because many thoughts are automatic and beyond clients’ awareness. Clients are taught that errors in thinking can directly cause depression. Treatment involves correcting cognitive errors and substituting less depressing and (perhaps) more realistic thoughts and appraisals. Later in therapy, underlying negative cognitive schemas (characteristic ways of viewing the world) that trigger specific cognitive errors are targeted, not only in the clinic but also as part of the client’s day-to-day life. The therapist purposefully takes a Socratic approach teaching by asking questions, making it clear that therapist and client are working as a team to uncover faulty thinking patterns and the underlying schemas from which they are generated. Therapists must be skillful and highly trained.

c. Interpersonal psycotherapy:  The interpersonal therapy (IPT) approach has not yet been subjected to as extensive an evaluation as cognitive-behavioral therapy, nor is it as widely available. However, the studies that have been completed strongly support its effectiveness for treating unipolar depression. Indeed, interpersonal therapy seems to be about as effective as medications or cognitive-behavioral treatment . This IPT approach focuses on current relationship issues, trying to help the person understand and change maladaptive interaction patterns . Interpersonal therapy can also be useful in long-term follow-up for individuals with severe recurrent unipolar depression.